Risk Adjustment CRC exam questions With Complete
Solutions
.E34.9, G63 Correct Answers A 62 year-old female with a long
standing history of endocrine disease has noticed numbness in
her hands and feet. She sees her physician and after
examination, her provider documents the following:A/P:
Polyneuropathy, due to endocrine disease. Will get new labs and
have patient return in four weeks.
"Consistent with" which means the same as suspected and is not
acceptable, use of up and down arrows, and reporting the
diagnosis code alone (must report diagnosis code with
description of code. Correct Answers Which one of the
following is NOT allowable for coding in the outpatient setting?
"Not coded here", code exluded should never be used at the
same time as the code above, whe two conditons cannot occur
together. Correct Answers Excludes 1
"Not otherwise specified" equivalent to unspecified. Correct
Answers NOS
1. There is a potential of loss of revenue
2. Billing compliance issues might come too light Correct
Answers Retrospective audits generally include finding
additional diagnoses, CMS has stated that the deletion of
conditions needs to be part of these audits; why is it so hard for
companies to follow CMS directives?
, 1.0 Correct Answers Each year, Medicare normalizes risk
scores to maintain an average of what?
1.Can be performed by internal employees.
2.Can be performed by external consultants who sign a business
agreement
3. Performed after data was submitted Correct Answers Which
statements are TRUE regarding retrospective audits?
1.Reporting the manifestation of a chronic illness
2. Disease interactions.
3.Patient age Correct Answers Which of the following can
effect RAF score?
5 Correct Answers How many records are submitted by health
plans per patient in a RADV audit?
60 days Correct Answers An addendum is used to include
information about what was done to the patient and should be
added within a reasonable time frame, which is usually capped
at a maximum of how many days after the encounter.
A/P: Mild CKD Correct Answers Which one of the following
physician's assessment supports the correct coding for CKD
stage 2, code N18.2?
A40.9, J15.4 Correct Answers Patient is admitted to the
hospital with streptococcal sepsis which has caused pneumonia.
What codes are assigned?
Solutions
.E34.9, G63 Correct Answers A 62 year-old female with a long
standing history of endocrine disease has noticed numbness in
her hands and feet. She sees her physician and after
examination, her provider documents the following:A/P:
Polyneuropathy, due to endocrine disease. Will get new labs and
have patient return in four weeks.
"Consistent with" which means the same as suspected and is not
acceptable, use of up and down arrows, and reporting the
diagnosis code alone (must report diagnosis code with
description of code. Correct Answers Which one of the
following is NOT allowable for coding in the outpatient setting?
"Not coded here", code exluded should never be used at the
same time as the code above, whe two conditons cannot occur
together. Correct Answers Excludes 1
"Not otherwise specified" equivalent to unspecified. Correct
Answers NOS
1. There is a potential of loss of revenue
2. Billing compliance issues might come too light Correct
Answers Retrospective audits generally include finding
additional diagnoses, CMS has stated that the deletion of
conditions needs to be part of these audits; why is it so hard for
companies to follow CMS directives?
, 1.0 Correct Answers Each year, Medicare normalizes risk
scores to maintain an average of what?
1.Can be performed by internal employees.
2.Can be performed by external consultants who sign a business
agreement
3. Performed after data was submitted Correct Answers Which
statements are TRUE regarding retrospective audits?
1.Reporting the manifestation of a chronic illness
2. Disease interactions.
3.Patient age Correct Answers Which of the following can
effect RAF score?
5 Correct Answers How many records are submitted by health
plans per patient in a RADV audit?
60 days Correct Answers An addendum is used to include
information about what was done to the patient and should be
added within a reasonable time frame, which is usually capped
at a maximum of how many days after the encounter.
A/P: Mild CKD Correct Answers Which one of the following
physician's assessment supports the correct coding for CKD
stage 2, code N18.2?
A40.9, J15.4 Correct Answers Patient is admitted to the
hospital with streptococcal sepsis which has caused pneumonia.
What codes are assigned?
